血流限制的低强度有氧训练对2型糖尿病患者糖代谢和睡眠时长的影响

The Effect of Blood Flow-restriction Low-intensity Aerobic Training on Glucose Metabolism and Sleep Duration in Type 2 Diabetes Mellitus Patients

目的:探讨血流限制结合低强度有氧训练(LI-BFRT)对2型糖尿病患者糖代谢调节及睡眠时长的影响。方法:36名2型糖尿病患者随机分为低强度有氧训练组(LI组,n=18)和血流限制的低强度有氧训练组(LI-BFR组,n=18),两组均进行40%储备心率(HRR)间歇踏车训练,5 min/次,休息1 min,重复6组;LI-BFR组在LI组基础上,在骑行时以压力带施加50%动脉闭塞压(AOP)的压力实现血流限制。两组训练均3次/w,共12 w。训练前后测空腹血糖(FPG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、定量胰岛素敏感性检测指数(QUICKI)、FPG增加值、入睡时间、起床时间、在床时长、睡眠时长、睡眠效率、在床时长增加值和睡眠时长增加值。结果:(1)干预结束后,与干预前相比,LI组仅FPG显著降低(P<0.01);LI-BFR组FINS降低(P<0.05),FPG、HbA1c和HOMA-IR显著降低(P<0.01);同时,LI-BFR组QUICKI显著增加(P<0.01)。与LI组相比,LI-BFR组FPG、HbA1c和HOMA-IR下降更加显著(P<0.05)。(2)干预结束后,与干预前相比,LI组睡眠时长显著增加(P<0.01),在床时长和睡眠效率增加(P<0.05);LI-BFR组在床时长增加(P<0.05),睡眠时长和睡眠效率显著增加(P<0.01)。与LI组相比,LI-BFR组睡眠效率增加更加明显(P<0.05)。(3)LI组睡眠指标和糖代谢指标间无明显相关性;LI-BFR组FPG增加值和睡眠效率(r=-0.566),FPG增加值和睡眠时长(r=-0.485),FINS和在床时长增加值(r=-0.512),FINS和睡眠时长增加值(r=-0.502),HOMA-IR和在床时长增加值(r=-0.536),HOMA-IR和睡眠时长增加值(r=-0.570)均呈负相关;QUICKI和睡眠时长增加值(r=0.597)、在床时长增加值(r=0.554)呈正相关。其他指标间不存在相关性。结论:(1)两种训练方式均可改善2型糖尿病患者糖代谢,LI-BFRT效果更明显;(2)LI-BFRT可以显著增加患者睡眠时长、提升睡眠效率;(3)在LI-BFRT的改善下,睡眠时长和糖代谢之间存在正相关,可以相互影响。

Objective To explore the effect of a twelve-week blood flow-restriction low-intensity aerobic training(LI-BFRT) on the glucose metabolism indexes and sleep duration of type 2 diabetes mellitus(T2DM) patients. Methods Totally 36 T2DM patients were randomly assigned to a low-intensity training group(LI,n=18) and a low-intensity training combined with blood flow-restriction group(LIBFR, n=18). The LI group underwent 6 rounds of 5-minute low-intensity[40% heart rate reserve(HRR)] cycling with an interval of 1-minute rest every day,while the LI-BFR group did the same exercise with 50% arterial occlusion pressure(AOP). All participants received twelve-week aerobic intervention with three sessions per week. Before and after the intervention,all patients were measured the fasting blood glucose(FPG),hemoglobin A1c(HbA1c),fasting insulin(FINS),Homeostatic model assessment of insulin resistance(HOMA-IR),quantitative insulin sensitivity check index(QUICKI),increment in FPG,sleep latency,time to get up,time in bed,sleep duration,sleep efficiency,as well as the increase in time in bed and sleep duration. Results(1) After the intervention,the FPG of LI group was significantly lower than before the intervention(P<0.01). Meanwhile,the average FINS decreased,and FPG,HbA1c and HOMA-IR decreased significantly(P<0.05 for all),but QUICKI increased significantly in LI-BFR group(P<0.01). Compared with LI group,the decrease in the average FPG,HbA1c and HOMA-IR of LI-BFR group was more significant after the intervention(P<0.05). After the intervention,the sleep duration of LI group increased significantly(P<0.05),with the time in bed and sleep efficiency also increasing(P<0.01). However,after the intervention,the time in bed increased(P<0.05) and the sleep duration and efficiency increased significantly for the LI-BFR group(P<0.01). Moreover,compared with LI group,the sleep efficiency of LI-BFR group increased more significantly(P<0.05).(3) There was no significant correlation between sleep indexes and glucose metabolism indexes in LI group. However,in LI-BFR group,the increase in FPG was negatively correlated to sleep efficiency(r=-0.566) and sleep duration(r=-0.485),so was the average FINS to increase in time in bed(r=-0.512) and sleep duration(r=-0.502),and HOMA-IR to increase in time in bed(r=-0.536) and sleep duration(r=-0.570),but QUICKI was positively correlated to increase in sleep duration(r=0.597) and time in bed(r=0.554). Conclusion(1) Low-intensity aerobic training can improve glucose metabolism in patients with type 2 diabetes,and the effect can be better if combined with blood-flow restriction.(2) LI-BFRT can significantly better patients’ sleep duration and efficiency.(3)LI-BFRT can induce positive correlation between sleep duration and glucose metabolism.